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As military veterans return from multiple tours in the Middle East, many are coming home with more than they bargained for. Research has shown that headaches often occur in tandem with conditions that commonly affect war veterans, such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression. With more than 1.6 million soldiers deployed to Iraq and Afghanistan since 2001, this relationship has been attracting increased public scrutiny and concern.

In a study published in the June 2008 edition of the journal Headache, U.S. soldiers were screen with 90 days of returning from a one-year combat tour in Iraq. Of these soldiers, 19% were found to have migraine, with an additional 17% suspected of having migraine. By comparison, the prevalence of migraine in the general population is approximately 10%.

A 2009 study from the Veterans Affairs Center of Excellence for Stress and Mental Health in La Jolla, Calif., found that both migraine and tension-type headache were significantly associated with PTSD and combat-related injury. Of the 308 veterans who visited the clinic for health services during the study, about 40% reported migraine and/or tension-type headache as a current problem.

“Veterans with PTSD were four times more likely to report current headache than veterans without PTSD symptoms,” says study lead Niloofar Afari, PhD, director of clinical affairs at the center. “Veterans with both migraine and tension-type headache had significantly higher rates of PTSD than those who had migraine or tension-type headache alone.”

The study also found that veterans with combat injuries unrelated to TBI were more than twice as likely to report a headache. It did not, however, find a significant increase in headaches in veterans with TBI, which runs contrary to other studies. Dr. Afari speculates that this may be because so few subjects reported having TBI without combat injury.

Another surprising find was that veterans with substance abuse problems were only half as likely to report having headaches, possibly because they are already self-medicating, Dr. Afari says.

These studies, like others that have preceded them, “speak very strongly to the need to assess and treat all the different problems that veterans are experiencing,” Dr. Afari says. “Veterans often come in to the VA and get tracked for one issue, like PTSD, when they would benefit from a more comprehensive assessment for both mental health and physical health consequences of combat.”

It also speaks to the need for better resources to help soldiers cope with headaches and other common post-combat issues. That’s why the National Headache Foundation (NHF) launched the War Veterans Health Resource Initiative. This site provides military men and women with a comprehensive list of resources for coping with neurological trauma—including headache and migraine—and other aspects of post-deployment life. Veterans can access links to information on a wide variety of topics, including military discounts, medical experts, treatment facilities, physical therapy, mental health counseling, job training, and disability claims assistance. There are also online forums where they can share stories and discuss experiences.

“People need to understand that migraine is not just a bad headache. It is a neurobiological disease that often comes with severe nausea, blinding light sensitivity, extreme noise sensitivity, vertigo, and visual aura that makes handling weapons and heavy equipment nearly impossible,” says Mar Husid, MD, director of the Walton Headache Center at Walton Rehabilitation Health System in Augusta, Ga. “It is a disease that can take a physically fit and mentally tough young soldier and remove him or her from active duty. The NHF site is going to be useful to my patients and their families in dealing with this challenge.”

Dr. Afari’s study received the 2011 Seymour Diamond Lectureship Award for being the most significant paper in the field of headache or pain published in the last year.